Web-Based Program Reduces Risk of Diabetes in Women

Jacinda Nicklas, MD, MPH, MA

Findings of recent research demonstrate an intervention program, Balance after Baby, is promising for decreasing diabetes risk factors in women with recent gestational diabetes.

The findings were presented as part of the American Diabetes Association’s (ADA’s) 80th Virtual Scientific Sessions.

Gestational diabetes complicates 3-7% of pregnancies, and the number is growing, Jacinda Nicklas, MD, MPH, MA, said during a presentation of her investigative team’s data and findings. What’s more, 30-70% of women with gestational diabetes develop type 2 diabetes within 10 years, and those with a history of gestational diabetes are more likely to retain and even gain weight postpartum. Obesity and weight gain are the strongest modifiable risk factors for type 2 diabetes.

Previous research found among women with a self-reported history of gestational diabetes in the Diabetes Prevention Program, those randomized to an intensive lifestyle program had a 53% risk reduction for type 2 diabetes.

Nicklas and a team of investigators adapted the Diabetes Prevention Program to help women overcome postpartum barriers through a web-based delivery intervention and remote coaching called Balance after Baby. As a pilot trial, the team conducted a randomized controlled trial at Brigham and Women’s Hospital of women with recent gestational diabetes from 6 week-12 months postpartum. The primary outcome was weight loss at 12 months from six-week weight and from pre-pregnancy weight.

The investigators noticed a significant change in weight for those randomized to the intervention (n=75 women). When the team looked from 6 weeks to 12 months, the control group gained almost 1 pound while the intervention group lost nearly 6 pounds (P=.0224).

There was also a difference in postpartum weight retention at 12 months. Women in the control group gained about 10 pounds while those in the intervention group lost slightly more than 1 pound (P=.0349).

Due to the success of the pilot trial, the investigators launched a more diverse study at 2 sites, 1 in Massachusetts and 1 in Colorado.

In total, 181 women were enrolled. The study population was enriched with Hispanic and low-income women. Women included met gestational diabetes criteria or had a clinician diagnosis, were >18 to <45 years old, and had a BMI at randomization of >24 kg/m². The intervention was delivered in both English and Spanish. Participants were randomized to either the Balance after Baby intervention or the control group. Those in the control group had access to a website with knowledge links about how to prevent type 2 diabetes.

For the intervention, women were asked to complete a module every week for the first 12 weeks, with bonus modules available thereafter. The website had places for tracking weight and steps, an area to complete action plans, a place to contact their lifestyle coach, and a community forum to interact with other participants.

The primary outcomes were weight loss at 12 months from 6 weeks postpartum and weight loss at 12 months from pre-pregnancy weight. There was an additional outcome to assess weight at 24 months, however, governmental regulatory delays caused the study to stop early, Nicklas said during the presentation.

Overall, for change in weight from 6 weeks to 12 months, the control group gained 1.3 pounds, while the intervention group lost 1.8 pounds (difference, 3.1 pounds; P=.09). When the team looked at weight retention at 12 months from pre-pregnancy weight, the control group gained 10.1 pounds while the intervention group gained 5.3 pounds (difference, 4.8 pounds; P=.04). The intervention was ineffective for Hispanic women, which was backed by the literature of low-income Hispanic women being less likely to engage in interventions and being twice as likely to experience significant postpartum weight retention versus White non-Hispanic women.

“The web-based Balance after Baby, through its effect on postpartum weight retention, has potential to delay or prevent development of type 2 diabetes in postpartum women with recent (gestational diabetes),” Nicklas concluded.

The study, “A Web-based Lifestyle Intervention To Reduce Postpartum Weight Retention In Women With Recent Gestational Diabetes: The Balance After Baby Intervention Trial,” was published as part of ADA 2020.